Varicocele and Retrograde Adrenal Metabolites Flow

Abstract

Background: Idiopathic varicocele is one of the causes of potentially correctable male subfertility. The mechanisms causing spermatogenesis impairment have yet to be clarified. The aim of this study is to analyze the effects of renal and adrenal metabolite reflux on testicular exocrine function in a rat experimental model. Materials and Methods: In the study, 45 male Lewis Stock adult rats, each weighing 300 g, were used. The rats were subdivided into three groups of 15 rats. In group A (control group) testicular volume and basal follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were measured at the beginning of the study and after 9 months. In group B, varicocele was induced by means of rings introduced in the left renal vein in order to cause a renospermatic reflux. In group C, similarly to group B, varicocele was induced after removal of left adrenal gland. The effects of varicocele on testicular function were then analyzed 3, 6 and 9 months after surgery. After 9 months, all rats underwent testicular biopsy. Results: Both groups B and C showed a reduction in testicular volume, an increase in FSH and a decrease in testosterone levels. These levels were higher in group B. Testicular histological assessment showed important structural abnormalities in group B rats. Conclusions: These data support the hypothesis that renal and adrenal metabolites enhance varicocele-induced testicular damage. This theory is supported both by hormonal impairment and testicular histological analysis.

Adolescent varicocoele management controversies

“…One concern about delayed surgical correction is that the testicular lesions caused by varicocoele, independent of patient age, are potentially irreversible (Sigman & Jarow, 1997;Camoglio et al, 2004). On the contrary, many studies have described significant improvement in semen quality after varicocoelectomy in both adults and adolescents (Dubin & Amelar, 1970;Lewis & Harrison, 1982;Chehval & Purcell, 1992;Paduch & Niedzielski, 1997).…”

Does Varicocelectomy Improve Gonadal Function in Men with Hypogonadism and Infertility? Analysis of a Prospective Study

“…Theories related to the negative effect of varicocele on testicular functions include testicular hyperthermia, hormonal dysfunctions, increased testicular blood flow due to venous engorgement, reflux of renal or perirenal metabolites, and hypoxia [2–4]. Weiss et al [5] reported impaired testosterone synthesis in patients with varicocele.…”

Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes

“…43 Reflux of blood down the testicular vein has been demonstrated in patients with varicoceles. 44,45 Abnormal blood flow It is postulated that increased blood flow to the testicle may lead to increased hydrostatic pressure and change in the composition of the interstitial fluid.…”